Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Medicare pays teaching hospitals for work by residents when a teaching physician supervises. During the 1990s, HHS concluded that many hospitals were billing for unsupervised services and began to audit invoices. There was also a GAO report and private litigation: qui tam suits under the False Claims Act, allowing relators to collect a bounty. Under 31 U.S.C. 3730(e)(4)(A), suits cannot be based upon public disclosure of allegations or transactions in public agencies’ official reports unless the relator is an original source of information. A prior case concluded that the 1998 GAO report and similar public documents disclosed that billing for unsupervised work was common practice. The district court dismissed a suit filed against a teaching hospital in 2004, claiming to describe conduct, such as inadequate supervision, not previously disclosed. The Seventh Circuit vacated. No one who read the GAO report, or followed the progress of the audits, would suspect that Rush University was misrepresenting "immediate availability" of teaching physicians during concurrently scheduled procedures. The complaint alleged a kind of deceit that the GAO report does not attribute to any teaching hospital.

After discovering that she had lung cancer that had spread to her brain, Killian underwent aggressive treatment on the advice of her doctor. The treatment was unsuccessful and she died months later. Her husband submitted medical bills for the cost of the treatments to her health insurance company. The company denied coverage on most of the expenses because the provider was not covered by the insurance plan network. The husband filed suit, seeking benefits for incurred medical expenses, relief for breach of fiduciary duty, and statutory damages for failure to produce plan documents. The district court dismissed denial-of-benefits and breach-of-fiduciary-duty claims, but awarded minimal statutory damages against the plan administrator. The Seventh Circuit affirmed the dismissals, rejecting an argument that the plan documents were in conflict, but remanded for recalculation of the statutory damages award.

Petitioner, then 45 years old and having previously worked in a factory and as a health aid, applied for disability benefits in 2004, claiming an onset date in 2004. Her conditions include peripheral vascular disease, chronic obstructive pulmonary disease, osteoarthritis, obesity, vascular dementia, depression, panic disorder, and anxiety. The Social Security Appeals Council denied review of the ALJ's adverse decision. The Seventh Circuit reversed and remanded. The ALJ failed to adequately consider petitioner's mental impairments, her obesity, and several of her physical problems.

Plaintiff first sought treatment in 1988, at age 27, experiencing double vision, eye strain, and facial numbness, and was diagnosed with abducens nerve palsy of the left eye. He continued to work as a welder until 2004, when symptoms forced him to sell his business. In 2007, he applied for disability insurance benefits, alleging onset in 2004. In 2010 an ALJ rejected the claim, concluding that plaintiff; she noted plaintiff’s complaints of headaches, but concluded that they must be non-severe. The district court upheld the denial. The Seventh Circuit remanded to the Social Security Administration, holding that the ALJ’s credibility determination was not supported by substantial evidence.

Rice, charged with attempted bank robbery, was known to have schizophrenia, and shortly before his death, was found incompetent to stand trial. Although seen by mental health professionals while detained, Rice often refused to take medications, eat, or bathe. He was hospitalized at psychiatric and other medical facilities several times and was awaiting placement at a state psychiatric facility. Rice died, about 15 months after arriving at the jail, of psychogenic polydipsia (excessive water drinking), a disorder known to manifest with schizophrenia. His estate filed suit under 42 U.S.C. 1983, alleging deliberate indifference. The district court entered summary judgment against the estate, which filed a second suit, reasserting state wrongful death claims previously dismissed. The judge dismissed, citing collateral estoppel, reasoning that a previous finding as to foreseeability of the cause of death precluded recovery on state claims. The Seventh Circuit reversed in part, holding that a material dispute of fact precluded summary judgment on one of the 1983 claims: that conditions of confinement were inhumane. The district court erred in dismissing state claims; the prior finding concerning foreseeability was not preclusive with respect to those claims.

Employers must maintain a log of work-related deaths, injuries, and illnesses, 29 C.F.R. 1904.4(a); an incident is "work-related" if "the work environment either caused or contributed to the resulting condition." Employees in the company's packing department fill containers, a process requiring repetitive hand movements, and pronation. When an employee developed lateral epicondylitis, painful swelling of ligaments and tendons around a joint, in her right arm, the company did not log the injury. The Department of Labor assessed a $900 penalty for failing to log a work-related injury. An ALJ sustained the penalty. The Occupational Safety and Health Review Commission declined review. The Seventh Circuit vacated, holding that substantial evidence was not enough to sustain the administrative decision. The ALJ was required to take account of competing evidence and inferences; the ALJ ignored strong indications that its favored witness was wrong. The court noted that inclusion of the work-relatedness requirement, requiring employers to judge the source of injury, "is a puzzle."

Insurers sought a declaration that they had no duty to defend or indemnify in tort suits brought against the insured village, concerning discovery of "perc," a carcinogenic common dry cleaning solvent, in one of its wells and the village's continued use of the well without disclosure. The district court, relying on a pollution exclusion in the policies, granted summary judgment for the insurers. The exclusion refers to "actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of 'pollutants'" and excludes from coverage expenses for "cleaning up ... or in any way responding to, or assessing the effects of pollutants." After exploring the reasons for the exclusion, the Seventh Circuit affirmed. The court rejected an argument that this was not a pollution case, because the amount of perc in the water was below the maximum level permitted by environmental regulations. The complaints actually filed "describe in copious detail the conduct giving rise to the tort suits, and in doing so inadvertently but unmistakably acknowledge the applicability of the pollution exclusion."

The Federal Trade Commission found that a merger between a health system and a hospital violated the Clayton Act, 15 U.S.C. 18. Plaintiffs sought treble damages and certification of a class of patients and third-party payors who allegedly paid higher prices for care. Under FRCP 23(b)(3), a class may be certified only if questions of law and fact common to members predominate over questions affecting only individuals in the class. Plaintiffs proposed to rely on economic and statistical methods used by the FTC and defendant's economic experts to analyze antitrust impact. The "difference-in-differences" method estimates price increases resulting from exercise of market power rather than from other factors. The district court denied certification, concluding that the expert had not shown that his methodology could address impact on a class-wide basis. The Seventh Circuit granted interlocutory appeal, vacated, and remanded. Although plaintiffs' expert initially believed that the health system did increase prices uniformly across all services, he acknowledged that it might not have done so, and explained how his methodology could show impact to the class despite such complications. The degree of uniformity the court demanded is not required; "it is important not to let a quest for perfect evidence become the enemy of good evidence."

A medical provider filed proofs of claim in about 3,200 bankruptcy cases, 2003-2008, listing the debtors' medical treatment information. The filings were public and available on the docket. Debtors filed class action suits under a statute that allows individuals to sue if their health care records are disclosed without permission, Wis. Stat. 146.84. The bankruptcy judge granted the provider summary judgment. The Seventh Circuit dismissed and remanded for lack of jurisdiction. Bankruptcy judges lack authority under Article III of the Constitution to enter final judgments on claims that constitute "the stuff of the traditional actions at common law." The debtors' claims are based on a state law that is "independent of the federal bankruptcy law" and not necessarily resolvable by a ruling on the creditor’s proof of claim in bankruptcy.

Plaintiff injured his back while working for defendant. Following worker's compensation leave, he returned to work as a long-haul driver and worked without incident for two years. With the birth of his child, he asked to switch to a city route. After the switch, plaintiff began having problems with his back and asked to switch back, but the collective bargaining agreement did not allow another change within a year, so the request was denied. He took medical leave, but sought to return to work as a long-haul driver, presenting a medical release which limited him to "road driver work" and "limited dock work." Defendant would not allow plaintiff to return, saying that it needed clarification on medical restrictions and that he could not return to work as a driver unless he received a medical release without restrictions. The district court granted employer summary judgment in a suit under the Americans with Disabilities Act, 42 U.S.C. 12102(2). The Seventh Circuit affirmed. Plaintiff is not substantially limited in the major life activity of working because he is capable of long-haul driving; at most, he is unable to work as a city driver because it involves short hauls and dock work that requires him to frequently load and unload cargo.